Sharafi Ahmad, Davoodi Saeed, Karimi Abbas Ali, Ahmadi Hosein, Abbasi Kyomars, Sheikh Fathollahi Mahmood, Bina Payvand, Soleymanzadeh Maryam, Fehri Arezoo, Davaran Saeid, Jahangheeri Siroos, Kassaian Seyed Ebrahim
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2013 Oct 28;8(4):177-81.
There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB.
Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death.
The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the ACEI/ARB positive and negative groups, respectively (OR: 0.628; p value = 0.09). Patients without ACEI/ARB were more likely to have a higher global ejection fraction.
Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested.
关于血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）在冠状动脉旁路移植术（CABG）术后死亡率方面的潜在益处/危害存在争议。本研究调查了CABG院内死亡率与术前使用ACEI/ARB之间的相关性。
在2006年至2009年连续接受单纯CABG的10055例患者中，4664例（46.38%）患者术前接受了ACEI/ARB治疗。数据来自德黑兰心脏中心心脏外科登记处。院内死亡率定义为手术同一住院期间内的死亡。在对混杂因素进行校正后，使用多变量逻辑回归模型评估术前ACEI/ARB治疗对院内死亡的影响。
患者的平均年龄为60.04±9.51岁，7364例（73.23%）为男性。87例（0.86%）患者在30天内死亡。多变量分析显示，ACEI/ARB的使用显著降低了院内死亡风险，因为ACEI/ARB阳性组和阴性组的死亡人数分别为33例（0.70%）和54例（1.0%）（比值比：0.628；p值=0.09）。未使用ACEI/ARB的患者更有可能具有较高的整体射血分数。
CABG患者术前使用ACEI可能与降低院内死亡率有关。建议进行大规模随机临床试验。
